Predicting cervical cancer screening participation using self-care behaviors among women in Iran

BACKGROUND

Cervical cancer screening is an effective and accessible method for preventing this cancer. However, low participation rates among women have been reported. Self-care is one of the solutions to improve access to health services. This study was conducted to determine the prediction of cervical cancer screening participation using self-care behaviors among women in Iran.

MATERIALS AND METHODS

This cross-sectional study was conducted on 310 eligible women who were referred to comprehensive health centers and women's clinics in teaching hospitals in Isfahan, Iran, from November 2020 to April 2021. Participants were enrolled using convenience sampling. The data collection tool included researcher-made questionnaires on personal and fertility characteristics, participation in cervical cancer screening, and self-care behaviors related to cervical cancer and its screening. Descriptive and inferential statistical methods were used for data analysis using the Statistical Package for the Social Sciences (SPSS) version 22 software.

RESULTS

The results showed that the intention to undergo screening was low among individuals who had not undergone screening. Lack of awareness and not having enough time were the most common barriers to screening. The results of logistic regression analysis indicated that self-efficacy was the significant predictor of cervical cancer screening. With an increase in the self-care score, the 12% chance of doing a Pap smear increases significantly (P = 0.002). Furthermore, the results of multiple regression showed that with an increase in the self-care score, the chance of women who refer to screening every year, every 2-3 years, and every 4-5 years is increased to 25% (P = 0.001), 34% (P < 0.001), and 11% (P = 0.032), respectively, compared with non-referral.

DISCUSSION

According to the results, self-care was a predictor of performing a Pap smear, and it was related to its regular performance of Pap smear too. Therefore, designing and implementing necessary interventions to increase self-care behaviors can improve women's participation in cervical cancer screening and its regularity.

HPV and Cervical Cancer Awareness and Screening Practices among Migrant Women: A Narrative Review

This narrative review explores the barriers and facilitators that migrant women face globally. The review explored a range of studies conducted in various countries, including the United States of America (USA), the United Kingdom (UK), Canada, Australia, and the United Arab Emirates (UAE). It also specialises in the experiences of migrant women living in Sydney, Australia, and women living in Ras Al Khaimah (RAK), UAE. Cervical cancer ranks as the fourth most prevalent form of cancer among women worldwide. It is the fourteenth most common cancer among women in Australia and the fourth most common cancer in the UAE. Despite the availability of vaccinations and cervical screening initiatives in many countries, including the USA, the UK, Canada, Australia, and the UAE, migrant women living in these countries continue to experience considerable health gaps when accessing cervical cancer screening services. Addressing these disparities is crucial to ensuring everyone has equal healthcare access. An electronic search was conducted using three databases to identify articles published between 2011 and 2021. Qualitative, quantitative, and mixed-methods research studies were included in the search. The identified factors were classified into categories of barriers and facilitators of cervical screening uptake, which were then sub-categorized. This narrative review examines the awareness of cervical cancer and screening behaviours, attitudes, barriers, and facilitators associated with cervical cancer screening. According to the study, several factors pose significant obstacles for migrant women worldwide, particularly those living in the USA, the UK, Canada, and Sydney, Australia, and Emirati and non-Emirati women (migrant women) residing in RAK when it comes to undergoing cervical cancer screening. These barriers include inadequate knowledge and emotional, cultural, religious, psychological, and organisational factors. On the other hand, social support, awareness campaigns, and the availability of screening services were found to promote the uptake of cervical cancer screening. The findings from this review suggest that healthcare providers should adopt culturally sensitive approaches to enhance awareness and encourage participation in screening programs among migrant women. Based on the findings of this narrative review, it is strongly suggested that healthcare providers and policymakers prioritise developing culturally sensitive screening initiatives for migrant women. It is essential to address the psychological and emotional barriers that prevent migrant women from accessing screening services. This can be accomplished by offering education and awareness campaigns in their native languages and implementing a community-based approach to encourage social support and increase awareness of cervical cancer and screening services. Furthermore, healthcare providers and organisations should provide educational tools that address common misconceptions based on cultural and religious factors that prevent women from accessing screening services.

Determinants of routine cervical screening participation in underserved women: a qualitative systematic review

OBJECTIVE

Routine, population-wide cervical screening programmes reduce cervical cancer incidence and mortality. However, socioeconomically deprived communities and ethnic minority groups typically have lower uptake in comparison to the general population and thus are described as 'underserved.' A systematic qualitative literature review was conducted to identify relevant determinants of participation for these groups.

METHODS

Online databases were searched for relevant literature from countries with well-established, call-recall screening programmes. Overall, 24 articles were eligible for inclusion. Data was synthesized via Framework synthesis. Dahlgren & Whitehead's social model of health was used as a broad a priori coding framework.

RESULTS

Participation was influenced by determinants at multiple levels. Overall, patient-provider relationships and peer support facilitated engagement. Cultural disparities, past healthcare experience and practical barriers hindered service access and exacerbated negative thoughts, feelings and attitudes towards participation. Complex interrelationships between determinants suggest barriers have a cumulative effect on screening participation.

CONCLUSIONS

These findings present a framework of psychosocial determinants of cervical screening uptake in underserved women and emphasise the role of policy makers and practitioners in reducing structural barriers to screening services. Additional work, exploring the experience of those living within socioeconomically disadvantaged areas, is needed to strengthen understanding in this area.

The impact of bilinguality and language context on the understanding of epistemic adverbs in health communication: the case of English and Russian

Aim

To explore how English epistemic adverbs, as used in health communication, are understood by speakers depending on their first language (L1) and language context.

Methods

We used an online dissimilarity rating task with paired doctors' opinions which differed only with respect to the embedded epistemic adverbs (e.g., This treatment definitely has side effects vs. This treatment possibly has side effects). In order to evaluate the possible effect of one's L1, we compared the ratings of English-speaking monolinguals and Russian-English bilinguals in Australia (Study 1). To evaluate the impact of language context, we compared the ratings of Russian-English bilinguals in Australia and Russia (Study 2). The data were interpreted using classical multidimensional scaling (C-MDS) analysis, complemented by cultural consensus analysis and hierarchical cluster analysis.

Results

The C-MDS analyses returned statistically acceptable results. Intragroup consensus was evident for all speaker groups. They all clustered the high confidence adverbs (clearly, definitely, and obviously) and the hearsay adverbs (presumably and supposedly) similarly. Effects of L1 were seen: for example, unlike the monolinguals, the Russian bilinguals did not include evidently with the high confidence adverbs (Study 1). An effect of context was also evident: Russian-English bilinguals in Australia most resembled the monolinguals in their understanding of epistemic adverbs. The way Russian-based bilinguals clustered epistemic adverbs reflected a less nuanced understanding (Study 2).

Conclusion

The subtle differences in how adverbs of likelihood and doubt are understood in health communication suggest extra care is needed when conveying risk and uncertainty to patients from diverse linguistic and/or cultural backgrounds to ensure mutual understanding and mitigate against miscommunication. The impact of L1 and language context on one's understanding highlights the need to explore more widely how epistemic adverbs are understood by diverse populations and, in doing so, improve healthcare communication practices.

Factors Affecting the Cervical Cancer Screening Behaviors of Japanese Women in Their 20s and 30s Using a Health Belief Model: A Cross-Sectional Study

In recent years, the incidence and mortality rates of cervical cancer (CC) have increased among young women. Cervical cancer screening (CCS) is crucial to reducing the incidence and mortality of CC in a country such as Japan, where it is challenging to raise HPV vaccination rates. The purpose of this study was to identify psychological and personal characteristics relating to CCS participation among young people by using the Health Belief Model (HBM). For this cross-sectional study, an internet survey was conducted between February–March 2018. Based on HBM and personal characteristics, χ2 tests and logistic analyses were used to identify factors influencing CCS. Responses obtained from 816 women in their 20s and 30s were used in the analysis. For HBM-based psychological characteristics, the odds ratios were significantly higher for “cues to participation in screening” and “barriers to participation at the time of cancer screening”, while “barriers to participation before cancer screening” showed significantly lower odds ratios. On the other hand, it was found that the presence of children and having regular health checkups affected the attributes of screening that were significant for decision-making. Therefore, it is important to create proactive measures to encourage younger women to undergo medical examinations.

Cervical Cancer Screening Among Immigrant Women Residing in Australia: A Systematic Review

Since the introduction of systematic population-based cervical cancer screening in Australia in 1991, age-standardized incidence of cervical cancer has halved. Given recent advances in human papillomavirus (HPV) vaccination and screening, cervical cancer may be eliminated nationally within 20 years. However, immigrant women are not equitably reached by screening efforts. This study systematically reviewed evidence on cervical cancer screening practices among immigrant women in Australia. A systematic search of MEDLINE, Embase, PubMed, CINAHL, and PsycINFO and gray literature for English language studies published till March 1, 2019, was conducted. Observational and qualitative studies evaluating cervical cancer screening awareness and participation of immigrant women were screened. Of 125 potentially relevant studies, 25 were eligible: 16 quantitative (4 cohort, 12 cross-sectional), 6 qualitative, and 3 mixed-methods studies. Quantitative studies indicated 1% to 16% lower screening rates among migrant women compared with Australian-born women, with participation of South Asian women being significantly lower (odds ratio = 0.54, 95% confidence interval = 0.48-0.61). Qualitative studies illustrated factors affecting women's willingness to participate in screening, including insufficient knowledge, low-risk perception, and unavailability of a female health professionals being key barriers. Future studies should focus on South Asian women, due to recent increase in their immigration.

Inequalities in adherence to cervical cancer screening in Portugal

Cervical cancer is the second cancer with the highest incidence and mortality in women aged 15-44 living in Europe. Screening is an effective strategy to reduce these rates, although in Portugal, as in other European countries, adherence to screening still presents significant disparities. Thus, this study aimed to assess the prevalence and factors associated with cervical cancer screening (CCS) nonadherence in Portugal. Cross-sectional data from 5929 women aged 25-64 included in the 2014 Portuguese National Health Survey (2014 NHS) were analyzed. The prevalence of CCS nonadherence was estimated. The association between multiple factors and CCS nonadherence was analyzed, using logistic regression, adjusting for age and educational level. The weighted prevalence of nonadherence was 13.2% [95% confidence interval (CI): 12.0-14.0]. Additionally, 10.5% of women had performed the last cervical cytology 3 years ago or more. Higher odds of nonadherence to screening were found for younger women, with low levels of education and income, unemployed, single, born outside Portugal, who never had a medical appointment or had over 12 months ago, who were never pregnant and who had never had a mammography. No association was found with other variables studied, including having public/private health insurance, BMI or smoking status. This study showed that inequalities in CCS adherence in Portugal persist. These findings reinforce the need for developing strategies to reduce inequalities in CCS adherence.

Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study

Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008–2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010–2012 and Health 2011 Survey; aged 30–64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9–66.6), Somalis 19% (16.4–21.6), Kurds 69% (66.6–71.1), and Finns 67% (63.3–69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74–1.16), Somalis 0.16 (0.11–0.22), and Kurds 1.37 (1.02–1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27–2.35), gynecological 2.47 (1.65–3.68), or other reasons 1.53 (1.12–2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.

International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants

Among the world's 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants' health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct healthcare system affecting their ability to find, evaluate, process, and use health information in the host countries. In this scoping review and commentary, we describe the health literacy issues of FSU immigrants and provide an overview of FSU immigrants' health literacy based on the integrated health literacy model. We purposefully consider the three most common locations where FSU immigrants have settled: the USA, Germany, and Israel. For context, we describe the healthcare systems of the three host countries and the two post-Soviet countries to illustrate the contribution of system-level factors on FSU immigrants' health literacy. We identify research gaps and set a future research agenda to help understand FSU immigrants' health literacy across countries. Amidst the ongoing global population changes related to international migration, this article contributes to a broad-scope understanding of health literacy among FSU immigrants related to the system-level factors that may also apply to other immigrants, migrants, and refugees.

Disparities in cervical screening participation: a comparison of Russian, Somali and Kurdish immigrants with the general Finnish population

Background

Cervical cancer is currently ranked as the fourth commonly diagnosed cancer in women globally. A higher incidence has been reported in low- and-middle-income countries, and the disease poses significant public health challenges. Evidence suggests that this disease is preventable by means of regular screening using the Papanicolaou (Pap) test. However, limited knowledge exists about disparities in cervical screening participation among immigrants compared with non-immigrants, in countries with universal cervical screening programmes. We aimed to examine disparities in cervical screening participation among women of Russian, Somali, and Kurdish, origin in Finland, comparing them with the general Finnish population (Finns). We controlled for differences in several socio-demographic and health-related variables as potential confounders.

Methods

We employed data from the Finnish Migrant Health and Well-being Study 2010–2012 and the National Health 2011 Survey. Data collection involved face-to-face interviews. Data on screening participation in the previous five years from women aged 29–60 were available from 537 immigrants (257 Russians, 113 Somalis, 167 Kurds) and from 436 Finns. For statistical analyses, we used multiple logistic regression.

Results

Age-adjusted screening participation rates were as follows: Russians 79% (95% CI 72.9–84.4), Somalis 41% (95% CI 31.4–50.1), and Kurds 64% (95% CI 57.2–70.8), compared with 94% (95% CI 91.4–95.9) among Finns. After additionally adjusting for socio-demographic and health-related confounders, all the immigrant groups showed a significantly lower likelihood of screening participation when compared with Finns. The Odds Ratios were as follows: Russians 0.32 (95% CI 0.18–0.58), Somalis 0.10 (95% CI 0.04–0.23), and Kurds 0.17 (95% CI 0.09–0.35). However, when additionally accounting for country of origin-confounder interactions, such differences were attenuated.

Conclusions

Our results indicate disparities in screening participation among these immigrants and a lower likelihood of screening participation compared with the general Finnish population. To improve equity in cervical cancer screening participation, appropriate culturally tailored intervention programmes for each immigrant group might be beneficial.

The sociology of cancer: a decade of research

Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.

The ambiguities of self-governance: Russian middle-aged middle-class women's reflections on ageing

In a youth-centred culture, where ageing is associated with physical and mental decline, investment in a youthful appearance promises access to socially valuable resources. The need for regular care for the self, primarily through consumption, constitutes part of the narrative of successful or positive ageing. Due to its emphasis on self-reliance and efforts to remain healthy, productive and youthful, the discourse of successful ageing has been seen as intersecting with a neoliberal rationality, or a shift of responsibility for risks associated with ageing from the state to the individual. While some authors criticise an emphasis on individual effort to maintain personal wellbeing for a lack of attention to structural factors, others view such an approach favourably as a way of transcending state paternalism. In this paper, I engage with the discourse of ‘responsibilisation’ drawing on the interviews with middle-aged, middle-class women from Moscow about their experiences of ageing. I employ the theoretical framework of ‘governmentality’ to demonstrate how the interviewed women's attempts to make sense of what it meant to age ‘appropriately’ within their milieus informed both their awareness of a need to improve and reinvent the self constantly through consumption in the context of post-Soviet Russian society, and their questioning of and resistance to this pressure.

Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis

OBJECTIVE

As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call-recall programme, in order to understand the barriers to informed uptake.

METHODS

We searched nine databases for English language peer-reviewed publications reporting on qualitative data from screening-eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call-recall programme. Evidence was integrated using thematic synthesis.

RESULTS

Thirty-nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action.

CONCLUSIONS

The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.

Cancer Screening among immigrants living in urban and regional Australia: results from the 45 and up study

Over 25% of the Australian population are immigrants, and are less active participants in cancer screening programmes. Most immigrants live in urban areas of Australia, but a significant proportion (~20%), live in regional areas. This study explored differences in cancer screening participation by place of birth and residence. Self-reported use of mammogram, faecal occult blood test (FOBT), and/or prostate specific antigen (PSA) tests was obtained from 48,642 immigrants and 141,275 Australian-born participants aged 50 years or older in the 45 and Up Study (New South Wales, Australia 2006-2010). Poisson regression was used to estimate relative risks of test use, adjusting for key socio-demographic characteristics. Overall, immigrants from Asia and Europe were less likely to have had any of the tests in the previous two years than Australian-born participants. Regional Australian-born participants were more likely to have had any of the tests than those living in urban areas. Regional immigrant participants were more likely to have had an FOBT or PSA test than those living in urban areas, but there were no differences in mammograms. This report identifies key immigrant groups in urban and regional areas that policymakers and healthcare providers should target with culturally appropriate information to promote cancer screening.

Breast cancer screening utilization among Eastern European immigrant women worldwide: a systematic literature review and a focus on psychosocial barriers

OBJECTIVE

Many countries host growing Eastern European immigrant communities whose breast cancer preventive behaviors are largely unknown. Thus, we aimed to synthesize current evidence regarding secondary prevention via breast cancer screening utilized by that population.

METHODS

All observational, general population studies on breast cancer screening with Eastern European immigrant women and without any country, language, or age restrictions were identified. Screening modalities included breast self-examination, clinical breast examination, and mammography.

RESULTS

The selected 30 studies were published between 1996 and 2013 and came from Australia, Canada, Denmark, Germany, Israel, the Netherlands, Spain, Switzerland, the UK, and the USA. The reported prevalence of monthly breast self-examination was 0-48%; for yearly clinical breast examination 27-54%; and for biennial mammography 0-71%. The substantial methodologic heterogeneity prevented a meta-analysis. Nonetheless, irrespective of host country, healthcare access, or educational level, the findings consistently indicated that Eastern European immigrant women underutilize breast cancer screening largely because of insufficient knowledge about early detection and an external locus of control regarding decision making in health matters.

CONCLUSIONS

This is a vulnerable population for whom the implementation of culturally tailored breast cancer screening programs is needed. As with other underscreened immigrant/minority groups, Eastern European women's inadequate engagement in prevention is troublesome as it points to susceptibility not only to cancer but also to other serious conditions for which personal action and responsibility are critical.